Table 7. A Call for Multi-system Change .

Key Themes	Sample Quotes
A need to re-imagine research	“There needs to be a reimagining of how you engage the sector in research” (21). “I think there needs to be that re-imagination.… this can’t be seen as something distinct from QI... but how do you make it an integral part of the work?SoI think they’ve really got to relook at their work through a different lens. … I believe there has to be ongoing and regular communication between universities and academics with the universities and the senior leadership both within regions and within governments… to develop these relationships and sustain them” (01). “Creating a culture of learning and innovation… ‘a way of approaching things.’ I get the need to have acentreof excellence, but at the end of the day, we need this to become the way we do work … Research, evaluation, innovation need to build into our system so that is at the heart of it and it feeds everything. As opposed to something you parachute in” (25).
Moving beyond an ‘acute care’ and clinical focus in research	“The research that you hear about is really about needing the foundations to raise money… for children’s programs and things like that. That’s kind of like, those are the okay places to do research, where the not so okay places are in public health and community and decision-making and things like that” (23). “There’s this kind of divide, right. There’s clinical research and then there’s community research or program evaluation or program development. And I would like to see that soften a bit - just be more of an open market around funding evaluation and research…” (25). “When you realize that about 90% of healthcare it’s within the community….likewe’re missing a major, major, major piece” (35). “Governments really care about a very small part of the health system. … It’s a small part of what ahealth systemsis and delivers” (01).
Rethinking research funding	“The grants are not tailored for the community servicepartners,they always require some specific Principal Investigator who has an academic affiliation” (18). “Need training for peer reviewers … looking at peer review practices, moving away from the traditional peer review to the broader peer review that encompasses patients, encompasses policy-makers, other relevant stakeholder groups” (26). “We get asked for hundreds of letters of support… it’s researchers looking to get a perspective of being seen as collaborative, and wanting to strengthen their application. But often there’s no flow of resources” (25). “And a much more open collaborative approach and a recalibration…. not just getting more funding to the select few with a strong research portfolio. I think restructuring at that level is needed” (21).
Improving academic preparation for health services research partnerships	“It’s mostly the academics who want to partner, that are really thinking of specific projects they want to partner on, and they just want money for those. Are they prepared to work with healthcare services? I don’t think they have that training to come in with” (18). “The need for leadership training for academics... such as LEAD - or a form of leadership development that equips them with the skills of understanding the issues related to system complexity, so they can get thathigh levelview of how and where their research fits into this big moving target” (31). “Researchers having, if they don’t already, training on how to enter communities and work with partners with that kind of humility that I mentioned… ensuring that researchers understand the different contexts that they are working in and the factors that could influence their success and their impacts on communities – being community in the large sense, including health systems, etc. Some maybe need some kind of crash course in the context... and training before they can understand what it means to communicate in that respectful way” (04).

Abbreviation: QI, quality improvement.